[The National List of recommendations-- what is it based on?]. / National Rekommandationsliste--hvad hviler den på?

The National List of recommendations is a scientific survey of the most used drugs. It separates the drugs into three groups: 1) recommended drugs, 2) drugs only to be used in special circumstances, and 3) drugs which should not be used in normal circumstances because of too limited efficacy or serious adverse reactions. The list is made by specialists chosen by the scientific bodies. The Institute of Rational Pharmacotherapy acts as secretariat. The primary selection criterion is the relationship between effect and adverse reactions, while price issues are not considered. Special consideration has been given to how the effect is expressed, composite measurements of effect and to extrapolation. The list, which is updated annually, is available at the IRF's homepage. The list of recommendations is primarily an instrument for general practitioners and drug committees; in future it should be integrated into the regional drug lists.

General practitioners prefer prescribing indicators based on detailed information on individual patients: a Delphi study.

OBJECTIVE: To assess the face validity of both simple and advanced quality indicators for prescribing in general practice. METHODS: In a three-round Delphi study, 100 randomly selected general practitioners (GPs) in Denmark rated 18 indicators for prescribing of non-steroidal anti-inflammatory drugs. All indicators were based on prescription register data and focused on different prescribing aspects. Advanced indicators contained information at the patient level, viz. age, sex and history of drug use, while simple indicators only used drug statistics at practice level. Indicators were rated on a nine-point Likert scale. Consensus among GPs was defined as interquartile ranges of three or less. A median rating of 7-9 was interpreted as face validity and a median rating of 1-3 as no face validity. RESULTS: Participation in the study was accepted by 44 GPs and 37 completed all three rounds. Three indicators based on patient level data and focusing on adverse effects were assessed to have face value. One indicator focusing on costs and based on practice level data was considered unsuitable for evaluating the quality of prescribing. Consensus was not reached for the remaining indicators. CONCLUSIONS: GPs do not regard simple indicators based on aggregated data at practice level as suitable for evaluating the prescribing quality in general practice, but prefer indicators that rest on clinical data at the patient level.

Therapeutic drug monitoring of antiarrhythmic drugs.

Most antiarrhythmic drugs fulfil the formal requirements for rational use of therapeutic drug monitoring, as they show highly variable plasma concentration profiles at a given dose and a direct concentration-effect relationship. Therapeutic ranges for antiarrhythmic drugs are, however, often very poorly defined. Effective drug concentrations are based on small studies or studies not designed to establish a therapeutic range, with varying dosage regimens and unstandardised sampling procedures. There are large numbers of nonresponders and considerable overlap between therapeutic and toxic concentrations. Furthermore, no study has ever shown that therapeutic drug monitoring makes a significant difference in clinical outcome. Therapeutic concentration ranges for antiarrhythmic drugs as they exist today can give an overall impression about the drug concentrations required in the majority of patients. They may also be helpful for dosage adjustment in patients with renal or hepatic failure or in patients with possible toxicological or compliance problems. Their use in optimising individual antiarrhythmic therapy, however, is very limited.

Utilisation of antibiotics in young children: opposite relationships to adult educational levels in Danish and Swedish counties.

BACKGROUND: Antibiotic utilisation varies profoundly among and within countries, and the extent of antibiotic utilisation correlates with the frequency of bacterial resistance, particularly among children. Hence, it is important to assess which factors may influence prescribing. In addition to variations in morbidity, health-care organisation, drug regulatory and supply systems, prescriber's attitudes, parents' behaviour, attitudes and socio-economic positions seem important. We compared socio-economic position (educational level of adults) and antibiotic utilisation in children in the municipalities within a Danish and a Swedish county which are geographically close, have similar social and economic development, and similar drug regulatory and supply systems. METHODS: Data on antibiotic utilisation (1998), expressed in defined daily doses per 1000 inhabitants per day (DDD/TID), were obtained from the Copenhagen County Health Insurance register and from the National Corporation of Swedish Pharmacies. Data on municipal educational levels were obtained from Statistics Denmark and Statistics Sweden. RESULTS: The utilisation of antibiotics in 0- to 6-year-old children was higher in the Swedish than in the Danish county but varied between the municipalities within both the Swedish (9.6-17.7 DDD/TID) and the Danish (8.0-12.9 DDD/TID) counties. Most notably, utilisation rates correlated negatively with the education levels in the Danish (r=-0.539, P=0.021) but positively in the Swedish (r=+0.390, P=0.025) municipalities. CONCLUSION: The observed variations in antibiotic prescribing may reflect different parental and/or prescriber attitudes towards use of antibiotics and they emphasise that antibiotic prescribing is influenced by factors other than the prevalence of bacterial infections. Relationships between socio-economic position (educational level) and drug utilisation should not be generalised from one area to another.

[Written drug information: do patients benefit?]. / Skriftlig laegemiddelinformation: gavner det patienterne?

INTRODUCTION: A survey was conducted to estimate the benefits of giving supplementary written drug information to the hospitalised patient. The impact on patient knowledge, satisfaction, and attitude towards taking medicine was examined, as was the patients' evaluation of the information material. MATERIAL AND METHODS: The study was carried out in a prospective, non-blind, controlled design. Seventy-eight patients took part in the survey: 35 in the intervention group and 43 in the control group. They were entered consecutively from four different sections of a medical ward, one of which served as the study section and the three others as the control group. The study period ran from November 1999 to July 2000. The patients in the study group were given supplementary drug information in writing. RESULTS: Patients in the study group knew more about the side effects of their drugs than did the patients in the control group. We did not record any differences between the two groups in the number of drug names remembered or knowledge of indications for the prescribed drugs. The number of newly prescribed drugs that, even after a reminder, remained completely unknown to the patient was lower in the study group (30%) than in the control group (55%). Overall, the patients' knowledge about their drugs seems small. Less than half the patients knew the indication for treatment of most (3/4) of their drugs. DISCUSSION: This survey shows that patients' knowledge about their drugs is inadequate. Simple, written information can improve this.